Tuesday, September 6, 2011

Is Medicine's 'July Effect' Myth or Reality?

Many medical insiders have suggested that every time the calendar turns to July, the massive turnover of medical staff throughout the U.S., usually numbering more than 100,000 personnel, contributes to a temporary drop in the quality of medical care and an increase in mortality as experienced teams are broken up and replaced with staff who are unfamiliar with their new hospital's procedures and culture. This has been called the "July effect."

Researchers at the University of California, San Francisco School of Medicine tested this hypothesis by analyzing 39 studies that had explored this topic and met strict inclusion criteria. Their conclusion--the July effect is, in fact, no myth.

As for the specific causes of the decline in care quality they identified, John Young, M.D., and colleagues said, "Unfortunately, our review discovered little evidence to discern to what extent worsened mortality and efficiency stem from clinical inexperience, inadequate supervision of trainees in new roles, and loss of 'system knowledge' due to cohort turnover." Among remedies suggested in an accompanying editorial in the July Annals of Internal Medicine are staggered starting schedules for trainees.

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